Palliative Care Guidelines - NHS Lanarkshire

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Palliative Care Guidelines: OxycodoneDose & Administration• Oxycodone injection:o Continuous subcutaneous infusion in a syringe driver or pump over 24 hours.o In addition, prescribe 1/6 th of the 24hour infusion dose subcutaneously, 1-2 hourly asrequired for breakthrough pain.o If the infusion dose is greater than 60mg / 24 hours, use another opioid for breakthroughinjections (low concentration of oxycodone preparation limits dose for SC injection to10mg in 1ml).o Diluent: water for injection.o Dose conversions are given below.• Stability and compatibility – see: Subcutaneous medication chart.Dose Conversions• Oxycodone is approximately twice as potent as morphine.Oral morphine 60mg ≈ oral oxycodone 30mg ≈ subcutaneous oxycodone 15mgSubcutaneous morphine 30mgSubcutaneous diamorphine 20mg≈ subcutaneous oxycodone 15mg≈ subcutaneous oxycodone 15mg• As with all opioid conversions, these are approximate doses.• Dose conversions should be conservative and doses rounded down.• Monitor the patient carefully so that the dose can be adjusted if necessary.• If the patient has opioid toxicity, reduce the dose by 1/3 rd when changing opioid.(See: Choosing & Changing opioids)ResourcesProfessional:Palliative Care Drug Information online: http://www.palliativedrugs.com/Patient:Patient leaflet on website: OxycodoneDischarge planning / Community use• The unscheduled care service should be informed that the patient is receiving this second lineopioid in a syringe driver or pump.• The Community Pharmacy Palliative Care Network stocks a limited supply of oral and injectionpreparations of oxycodone for emergency use.Key references1. Shah S, Hardy J. Oxycodone: a review of the literature. European J Palliative Care 2001; 8: 93-962. Smith M et al. Oxycodone has a distinctly different pharmacology from morphine. European J Pain 2001; 15(Suppl A): 135–136.3. Mucci-LoRusso P et al. Controlled release oxycodone compared with controlled release morphine in thetreatment of cancer pain: a randomised, double blind parallel group study. European J Pain 1998; 2: 239-249Further reading: http://www.palliativecareguidelines.scot.nhs.uk2 Issue date: January 2009 Review date: March 2012 © NHS Lothian
Pain Assessment for People with CognitiveImpairment / Communication DifficultiesPalliative Care Guidelines: Pain AssessmentAims• Involve the patient as muchas possible in the assessmentand management of theirpain.• Use a team approach; involvethe family, staff and carerswho know the patient well.• Assess each pain separatelyand identify the likelycause(s).• Assess the impact of the painon the patient and family.• Make a diagnosis and explainthis to the patient and family.• Agree a pain managementplan.1. Is pain the maincause of the patient’sdistress?2. Is the pain severe andoverwhelming?3. Can the patientparticipate in theassessment?4. Is there a carer, friendor staff member whoknows the patientand can help withassessment?Pain is often poorly assessedand inadequately managed inpeople with dementia, learningdisabilities or a stroke.Seek adviceExclude other problems• fear, anxiety or disorientation/ isolation• other physical symptoms – eg constipation• delirium or chronic confusion• stress related behavioursImmediate treatment may be required beforefurther assessmentAdjust the dose of analgesia to take account of recentanalgesic use.Seek adviceEnhance verbal and non-verbal communication• Allow plenty of time.• Use sensory aids where needed- hearing aid, glasses,signing, visual tools.• Minimise distractions – noise, bright lights, activity.• Use the person’s preferred name at the start of eachquestion to hold their attention and focus.• Use simple language; short sentences.• Repeat questions; check understanding.• Consider using pictures – body maps, photographs,illustrated booklets.Find out• How the patient usually behaves when comfortable.• How the patient usually expresses themselves whenin pain.• If the patient has had previous pain problems due to along term condition (e.g. arthritis).• About any non-drug treatments used for pain reliefand medications currently or previously used,including their effectiveness and any side effects.Actions• Record your assessment; consider using a behavioural tool(eg. Abbey, Doloplus 2, DisDAT)• Different pains may require different interventions. Themanagement of distress related behaviour is important.(See: Pain management)• Decide if the Adults with Incapacity Act is needed to covertreatment. (See guideline on website)• Discuss management with patient / carers. A trialof analgesics and / or non-drug treatments may beappropriate. If opioids are required, discuss any concernsregarding their use.• Agree goals for pain relief and a monitoring plan.Reassess regularlySee website for references and online resources including behavioural pain assessment tools.http://www.palliativeguidelines.scot.nhs.uk© NHS Lothian Issue date: January 2009 Review date: March 20121
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Palliative Care Guidelines - NHS Lanarkshire

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